(274) Endangered Beats: Impact of Atrial Fibrillation on Mortality in Myxedema Coma

Introduction: Myxedema coma is a severe complication of hypothyroidism characterized by a significant reduction in metabolic activity. This manifests as altered mental status, hypothermia, and hypotension, often accompanied by concurrent bradycardia. Our investigation explores the impact of atrial fibrillation on the clinical progression of myxedema coma, with the objective of providing critical insights into its implications on patient mortality.

Methods: The Nationwide Inpatient Sample from year 2016 to 2020 were utilized to identify hospitalized patients above the age of 18, with myxedema coma as their primary diagnosis. These individuals were categorized into two groups based on the presence or absence of atrial fibrillation. A multivariate regression analysis was conducted to assess the impact of atrial fibrillation on mortality rates across all hospitalizations for myxedema coma. The analysis controlled for key variables including age, sex, race, and comorbidities such as heart failure, valvular heart disease, chronic obstructive pulmonary disease, tobacco use, coronary artery disease, diabetes mellitus, and chronic kidney disease.

Results: In our study of 13,410 hospitalizations for myxedema coma, the average age of patients was 67 years, and 67% were female, predominantly of White ethnicity. Among these cases, 19.09% (2,560 patients) had atrial fibrillation. Our analysis indicated significantly elevated odds of mortality (1.35 [1.04-1.75], P=0.022) in patients with myxedema coma who had concurrent atrial fibrillation, compared to those without atrial fibrillation.

Conclusions: While typically linked to tachyarrhythmia and frequently observed in hyperthyroidism, atrial fibrillation has been found to precipitate complications in myxedema coma. These findings highlight the crucial requirement for increased clinical awareness and management approaches for myxedema coma patients with concurrent atrial fibrillation, aiming to improve prognosis and mitigate negative outcomes. Additional research is needed to advance personalized and precision medicine approaches based on this correlation, to facilitate the development of individualized management strategies.